Abstract

PURPOSE:

To evaluate the impact of a multidisciplinary clinic on the clinical care recommendations of patients with pancreatic cancer compared with the recommendations the patients received prior to review by the multidisciplinary tumor board.

METHODS:

The records of 203 consecutive patients referred to the Johns Hopkins pancreatic multidisciplinary clinic were prospectively collected from November 2006 to October 2007. Cross-sectional imaging, pathology, and medical history were evaluated by a panel of medical/radiation oncologists, surgical oncologists, pathologists, diagnostic radiologists, and geneticists. Alterations in treatment recommendations between the outside institution and the multidisciplinary clinic were recorded and compared.

RESULTS:

On presentation, the outside computed tomography (CT) report described locally advanced/unresectable disease (34.9%), metastatic disease (17.7%), and locally advanced disease with metastasis (1.1%). On review of submitted imaging and imaging performed at Hopkins, 38 out of 203 (18.7%) patients had a change in the status of their clinical stage. Review of the histological slides by dedicated pancreatic pathologists resulted in changes in the interpretation for 7 of 203 patients (3.4%). Overall, 48 out of 203 (23.6%) patients had a change in their recommended management based on clinical review of their case by the multidisciplinary tumor board. Enrollment into the National Familial Pancreas Tumor Registry increased from 52 out of 106 (49.2%) patients in 2005 to 158 out of 203 (77.8%) with initiation of the multidisciplinary clinic.

CONCLUSION:

The single-day pancreatic multidisciplinary clinic provided a comprehensive and coordinated evaluation of patients that led to changes in therapeutic recommendations in close to one-quarter of patients.

On review of both the outside as well as repeat CT scan imaging obtained at the time of the multidisciplinary clinic, 38 out of 203 (18.7%) patients had a change in the status of their clinical stage based on re-review of cross-sectional imaging.

Example case of change in diagnosis following review of the histologic slides by dedicated pancreatic pathologist. Although the patient initially presented with a diagnosis of pancreatic adenocarcinoma, the diagnosis was changed to microcystic (serous) cystadenoma. Note the multiple small back-to-back cysts lined by uniform flat or short cuboidal cells with clear cytoplasm on both low-(A) and high-power (B) views of the core-needle biopsy specimen of the pancreas.

Example case of change in resectability status of pancreatic lesion. The patient was deemed unresectable at the outside institution because of tumor abutment to the portal/superior mesenteric vein. However, the patient was reclassified as resectable with planned concomitant resection and reconstruction of the portal–superior mesenteric vein following review at multidisciplinary conference.